Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists, chiropractors, massage therapists, athletic trainers, osteopaths, and physicians to treat musculoskeletal pain and disability; it most includes kneading and manipulation of muscles, joint mobilization and joint manipulation.A 2011 literature review indicates that placebo is one of likely many potentially relevant mechanisms through which manual therapy improves clinical outcomes related to musculoskeletal pain conditions.